Healthcare Provider Details

I. General information

NPI: 1669394714
Provider Name (Legal Business Name): VENESA RICHARDS-JOHNSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2395 WALL ST SE STE 180
CONYERS GA
30013-6703
US

IV. Provider business mailing address

1376 VILLAGE BROOK DR
DACULA GA
30019-3500
US

V. Phone/Fax

Practice location:
  • Phone: 770-809-1100
  • Fax:
Mailing address:
  • Phone: 406-945-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberGAA-NP005092
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: